The History of Psychedelic Therapy with the Dying

Stanislav Grof & Joan Halifax

Our experience with persons dying of incurable diseases has
been closely associated with the development of psychedelic
therapy, a comprehensive program of brief psychotherapy utilizing
mind-altering substances such as lysergic acid diethylamide (LSD)
and dipropyltryptamine (DPT). Although this treatment is a direct
outgrowth of modern pharmacological and clinical research, it has
close parallels in various contemporary non-Western cultures and
its roots reach back to prehistory and the shamanic rituals and
healing ceremonies of many ancient civilizations.
The first suggestion that psychedelic substances could be
useful in the therapy of individuals dying of incurable diseases
came from pediatrician Valentina Pavlovna Wasson. After many
years of intensive ethnomycological studies, she and her husband,
Gordon Wasson, became interested in the use of psychedelic
mushrooms in pre-Columbian cultures and in contemporary Central
America. They made several field trips to Mexico to explore this
issue, and finally in June 1955 they became the first Westerners
to be admitted to a sacred ritual conducted by the Mazatec curandera,
or medicine woman, Maria Sabina. The Wassons were deeply
impressed by the powerful effect of the mushrooms that they
ingested in this ceremony. Roger Heim, the French mycologist
whose aid the Wassons sought, identified the mushrooms
botanically as Psilocybe mexicana and its congeners; he
then sent samples to the laboratories of the Swiss pharmaceutical
company, Sandoz, for chemical analysis. In 1957 Valentina
Pavlovna Wasson gave an interview in This Week magazine
about the history of this discovery and her own experience after
the ingestion of the Mexican sacred mushrooms. She expressed the
opinion that if the active agent could be isolated and a
sufficient supply assured, it might become a vital tool in the
study of psychic processes. She also stated that as the drug
would become better known, medical uses would be found for it,
perhaps in the treatment of alcoholism, narcotic addiction,
mental disorders, and terminal diseases associated with severe
pain. Several years later a team of researchers working in
Baltimore independently tested the validity of her unusual
vision. A group of psychiatrists and psychologists at the
Maryland Psychiatric Research Center who were not familiar with
the article in This Week conducted systematic studies of
psychedelic therapy with LSD, a drug closely related to
psilocybin, for exactly the same indications that Valentina
Wasson predicted. We ourselves were surprised to discover the
newspaper clipping in Gordon Wasson's library during a 1974 visit
to his home.
The next stimulus for the use of psychedelics with dying
individuals did not come from a physician or behavioral scientist
but from the writer and philosopher, Aldous Huxley. He was
profoundly interested both in the phenomenon of dying and in the
religious and mystical experiences induced by psychedelic drugs.
With unusual sensitivity and insight he assisted his first wife,
Maria, when in 1955 she was dying of cancer. During her final
hours he used a hypnotic technique to bring her into touch with
the memory of ecstatic experiences that had occurred
spontaneously on several occasions during her life. The explicit
goal was to facilitate her experience of dying by guiding her
toward these mystical states of consciousness as death was
approaching. This deep personal experience has its parallel in
Huxley's novel Island, where the character Lakshmi is
dying under very similar circumstances. In a letter to Humphry
Osmond, a psychiatrist and pioneer in psychedelic research who
introduced him to LSD and mescaline, Huxley wrote:

My own experience with Maria convinced me that the living
can do a great deal to make the passage easier for the dying,
to raise the most purely physiological act of human existence
to the level of consciousness and perhaps even of
spirituality.

To those who are familiar with the effects of hallucinogenic
drugs and with Huxley's personal history, there is no doubt that
the "soma" in Brave New World and the ''moksha
medicine'' in Island are psychedelic substances similar in
their effects to LSD, mescaline, and psilocybin. In Huxley's
vision "moksha medicine'' gives inhabitants of the island
mystical insights that free them from the fear of death and
enable them to live more fully. In another letter to Humphry
Osmond written as early as February 1958, Huxley was quite
explicit about his idea of seriously considering the use of LSD
with dying individuals:

... yet another project--the administration of LSD to
terminal cancer cases, in the hope that it would make dying
more spiritual, less strictly physiological process.

According to his second wife, Laura, Aldous mentioned on
several occasions that ''the last rites should make one more
conscious rather than less conscious, more human rather than less
human.'' In 1963, when he was himself dying of cancer, Huxley
demonstrated the seriousness of his vision. Several hours before
his death he asked Laura to give him 100 micrograms of LSD to
facilitate his own dying. This moving experience was later
described in Laura Huxley's book, This Timeless Moment.
Aldous Huxley's suggestion, although reinforced by his unique
personal example, for several years had no influence on medical
researchers. The next contribution to this area came from a
rather unexpected source and was unrelated to Huxley's thinking
and efforts. In the early 1960s Eric Kast of the Chicago Medical
School studied the effects of various drugs on the experience of
pain in the quest for a good and reliable analgesic. He became
interested in LSD as a possible candidate for such a substance
because of certain peculiarities of its effect on humans. He
learned that LSD tends to produce a marked distortion of the body
image and alterations of body boundaries; furthermore, it seemed
to interfere with the ability to concentrate and maintain
selective attention on a particular physiological sensation.
Thus, in individuals who are under the influence of LSD, simple
visual impressions may take precedence over sensations of pain or
concerns related to survival. Both the effect of LSD on the body
image and its interference with selective focus on significant
input seemed to be worth exploring in terms of their potential
for altering the perception of physical pain.
In a paper published in 1964 Kast and Collins described the
results of a study in which the hypothetical analgesic properties
of LSD were compared to those of two established and potent
drugs, dihydromorphinone (Dilaudid) and meperidine (Demerol). In
a group of fifty individuals suffering from severe physical pain
were thirty-nine patients with various types and stages of
cancer, ten patients with gangrenes of feet or legs, and one with
severe herpes zoster (shingles). The outcome of the statistical
analysis of this comparison indicated that the analgesic effect
of LSD proved to be superior to both Dilaudid and Demerol. In
addition to pain relief, Kast and Collins noticed that some of
these individuals showed a striking disregard for the gravity of
their personal situations. They frequently talked about their
impending death with an emotional attitude that would be
considered atypical in our culture; yet it was quite obvious that
this new perspective was beneficial in view of the situation they
were facing.
In a later study of 128 individuals with metastatic cancer,
Kast explored in more detail some of his earlier findings. This
time he was interested not only in the effects of LSD on pain but
also on some additional parameters: emotional changes, sleep
patterns, and attitudes toward illness and death. In view of the
fact that there was no psycho therapeutic emphasis and the
patients were not even informed that they were being given LSD,
the results were quite remarkable. A precipitous drop in pain
occurred in many individuals about two to three hours after the
administration of 100 micrograms of LSD and lasted an average of
twelve hours; pain intensity for the whole group (not necessarily
for every patient) was decreased for a period of three weeks. For
about ten days after the session, Kast observed improvement of
sleep and a less concerned attitude toward illness and death.
In 1966 Kast published another paper in which he paid more
explicit attention to the influence of LSD on the religious and
philosophical experiences and ideas of the patients. The group he
studied consisted of eighty persons suffering from terminal
malignant disease, with estimated life expectancies of weeks or
months, each of whom had been fully informed of the diagnosis. In
contrast to earlier studies, the LSD sessions were terminated by
an intramuscular injection of 100 milligrams of chlorpromazine
upon the appearance of fear, panic, unpleasant imagery, or the
desire to rest. The beneficial influence of a single
administration of 100 micrograms of LSD on physical pain, mood,
and sleep patterns was similar to the preceding studies. In
addition, Kast described a variety of changes in the patients
that made their situation more tolerable. He noticed improved
communication both between the observer and the patients and
among the patients themselves; this enhanced their morale and
self-respect and created a sense of cohesion and community among
them. Quite significant, also, was the occurrence of "happy,
oceanic feelings" lasting up to twelve days following the
administration of LSD. Kast stated explicitly that a certain
change in philosophical and religious attitudes in relationship
to dying took place that were not reflected in his numerical data
and graphs.
In spite of what to an LSD therapist might at present appear
as shortcomings in Kast's studies, the historical value of his
pioneering effort is unquestionable. He not only discovered the
analgesic value of LSD for some patients with intractable pain,
but he also brought forth the first experimental evidence for
Aldous Huxley's suggestion that the administration of LSD might
ease the encounter with death in persons suffering from cancer.
Kast concluded the last of his studies by stating that, according
to his observations, LSD is capable not only of improving the lot
of dying individuals by making them more responsive to their
environment and family, but it also enhances their ability to
appreciate the nuances and subtleties of everyday life. It gives
them aesthetic satisfaction and "creates a new will to live
and a zest for experience, which, against a background of dismal
darkness and preoccupying fear, produces an exciting and
promising outlook."
The encouraging results of Kast's studies inspired Sidney
Cohen, a prominent Los Angeles psychiatrist, friend of Aldous
Huxley, and one of the pioneers in LSD research, to start a
program of psychedelic therapy for individuals dying of cancer.
Unfortunately the results of his study and the details of his
treatment procedure have never been published. In a 1965 article
Cohen expressed his feelings about the potential of psychedelic
therapy for the dying, based on his pilot experiments with a
small group of patients. He stated that his own work confirmed
Kast's findings about the beneficial effect of LSD on severe
physical pain and suggested that LSD may one day provide a
technique for altering the experience of dying. Cohen saw clearly
the importance of this research endeavor: "Death must become
a more human experience. To preserve the dignity of death and
prevent the living from abandoning or distancing themselves from
the dying is one of the great dilemmas of modern medicine."
Cohen's co-worker, Gary Fisher, later published a paper in
which he discussed the personal and interpersonal problems of the
dying. In this context he emphasized the significance of
transcendental experiences--whether spontaneous, resulting from
various spiritual practices, or induced by psychedelic drugs. As
a result of such experiences the individual ceases to be
concerned about his or her own physical demise and begins to see
it as a natural phenomenon of the cycling of the life force. This
acceptance drastically alters a person's life-style; the
individual no longer reacts with panic, fear, pain, and
dependency to the changes that are occurring. Rather, the patient
is willing and eager to share this new knowledge with close
family members and friends. Fisher discussed the use of LSD
therapy within the framework of a research project where this
drug was compared with an experimental analgesic and only one
hour was allowed for preparing patients for the session. In spite
of this limitation, he observed what he described as dramatic
results in terms of pain reduction, psychological aftereffects,
and adjustment of the patients to their impending deaths.
Another series of observations that was later integrated into
the concept of psychedelic therapy for the dying originated in
the Psychiatric Research Institute in Prague, Czechoslovakia. A
research team of this institute headed by Stanislav Grof
(coauthor of this book) conducted experiments in the early 1960s
with psychiatric patients, exploring the potential of LSD for
personality diagnostics and psychotherapy. These efforts finally
resulted in treatment that involved intense psychological work
and a series of therapeutic sessions with LSD. Although this
approach was initially based in theory and practice on
psychoanalysis, in the course of years it underwent substantial
modifications and became an independent therapeutic procedure
combining work on psychodynamic issues with a definite emphasis
on transpersonal and transcendental experiences.
In the exploratory phase of this work, all psychiatric
patients from various diagnostic categories undergoing serial LSD
sessions sooner or later transcended the psychoanalytic framework
and spontaneously moved into experiential realms that have been
described through millennia as occurring in various schools of
the mystical tradition, temple mysteries, and rites of passage in
many ancient and pretechnological cultures of the world. The most
common as well as the most important of these phenomena were
experiences of death and rebirth, followed by feelings of cosmic
unity. This profound encounter with one's own impermanence and
mortality was very complex and had biological, emotional,
intellectual, philosophical, and metaphysical dimensions.
Experiences of this kind seemed to have had very beneficial
consequences for these psychiatric patients; some very dramatic
improvements of various psychopathological conditions were
observed immediately following the death-rebirth phenomenon and,
in particular, the experiences of oneness with the universe. This
suggested the existence of a powerful therapeutic mechanism as
yet unknown to Western psychiatry and psychology that appeared
far superior to those used in conventional psychotherapy.
Many individuals who had the experience of death and rebirth
sometimes accompanied by feelings of cosmic unity independently
reported that their attitudes toward dying and their concepts of
death underwent dramatic changes. Fear of their own physiological
demise diminished, they became open to the possibility of
consciousness existing after clinical death, and tended to view
the process of dying as an adventure in consciousness rather than
the ultimate biological disaster. Those of us conducting this
research kept witnessing, to our great surprise, a process that
bore a striking similarity to mystical initiation and involved
experiential sequences that resembled those described in the Tibetan
or Egyptian Book of the Dead.
The claims of changes in attitudes toward death were so
frequent that it seemed important to test their practical
relevance. It was obvious that a deep change of consciousness of
that sort could be very beneficial for dying individuals,
particularly those with chronic, incurable diseases. The first
author (S.G.) then had an opportunity to work with several
persons diagnosed with cancer. These pilot observations indicated
that the alleviation of the fear of death earlier reported as a
result of LSD therapy in psychiatric patients (most of whom were
young and physically healthy) can occur also in those for whom
the issue of death is of immediate relevance. At this point the
Prague group began seriously discussing the possibility of
working systematically with dying people, and Grof designed a
research program using serial LSD sessions with individuals dying
of cancer. These plans were interrupted by a fellowship granted
to him by the Foundation's Fund for Research in Psychiatry in New
Haven, Connecticut, that took him to the United States.
After his arrival in Baltimore in March 1967, he joined the
team in the Research Unit of Spring Grove State Hospital, which
later became the core of the Clinical Sciences Department of the
newly built Maryland Psychiatric Research Center. Here he found,
to his surprise, that some time prior to his arrival this group
had been interested in exploring the potential of LSD
psychotherapy for alleviating the emotional and physical
suffering of cancer patients. The sequence of events that spurred
the interest of the research team in this problem area, briefly
described, is this: Since 1963 a group of psychiatrists,
psychologists, and social workers at Spring Grove had been
exploring the effects of a brief course of LSD-assisted
psychotherapy on the drinking behavior, psychological condition,
and social adjustment of alcoholics. In a parallel study the
therapeutic potential of this new treatment was tested in a group
of neurotic patients. During the assessment, based on clinical
interviews as well as psychological testing, the symptoms
particularly responsive to psychedelic therapy appeared to be
depression and anxiety.
In 1965, when the studies with alcoholics and neurotics were
well under way, the Spring Grove research team first focused its
attention on the needs of dying cancer patients in an unforeseen
and tragic manner. A professional member of the research team,
Gloria, a woman in her early forties, developed a carcinoma of
the breast. She had undergone a radical mastectomy; subsequent
surgery had revealed inoperable metastases of the liver. Although
still ambulatory, she was in severe physical and emotional
distress. She was fully aware of her condition and her prognosis
and shared her feelings of despair with staff members. On the
basis of the relief of depression and anxiety frequently observed
in psychiatric patients following LSD-assisted psychotherapy,
Sidney Wolf, a psychologist and member of the therapeutic team,
suggested that the psychedelic treatment procedure might prove
helpful to his colleague. It seemed possible that her depression
and anxiety, although reactive in nature and well substantiated
by a painful life situation, might respond favorably to LSD
therapy, as was the case in other conditions of a psychogenic
nature.
After discussions with her husband, her physician, and with
the approval of all concerned, a course of psychedelic therapy
was initiated, with Sidney Wolf in the role of "sitter.'' In
the treatment plan at Spring Grove the primary objective was to
facilitate the occurrence of a psychedelic peak experience in the
context of brief but intensive psychotherapy. The preparation for
the session lasted somewhat over a week; the focus was on the
issue of personal identity and on current interpersonal
relationships. When most of the important areas involved were
satisfactorily clarified, a 200-microgram LSD session was
conducted under conditions quite similar to those used for
psychiatric patients. The outcome of this pioneering experiment
was quite remarkable: After careful preparation and several
subsequent drug-free interviews a single LSD experience seemed to
have changed the quality of Gloria's remaining days. Shortly
after the LSD session she went on vacation with her husband and
children. Upon her return, two weeks after the session, she
completed the following retrospective report:
''The day prior to LSD, I was fearful and anxious. I would at
that point have gratefully withdrawn. By the end of the
preparatory session practically all anxiety was gone; the
instructions were understood and the procedure clear. The night
was spent quietly at home; close friends visited and we looked at
photograph albums and remembered happy family times. Sleep was
deep and peaceful. I awakened refreshed, and with practically no
fear. I felt ready and eager. The morning was lovely, cool and
with a freshness in the air. I arrived at the LSD building with
the therapist. Members of the department were around to wish me
well. It was a good feeling.
''In the treatment room was a beautiful happiness rosebud,
deep red and dewy, but disappointingly not as fragrant as other
varieties. A bowl of fruit, moist, succulent, also reposed on the
table. I was immediately given the first dose and sat looking at
pictures from my family album. Gradually, my movements became
fuzzy and I felt awkward. I was made to recline with earphones
and eyeshades. At some point the second LSD dose was given to me.
This phase was generally associated with impatience. I had been
given instructions lest there be pain, fear, or other
difficulties. I was ready to try out my ability to face the
unknown ahead of me and to triumph over my obstacles. I was
ready, but except for the physical sensations of awkwardness and
some drowsiness nothing was happening.
''At about this time, it seems, I fused with the music and was
transported on it. So completely was I one with the sound that
when the particular melody or record stopped, however
momentarily, I was alive to the pause, eagerly awaiting the next
lap of the journey. A delightful game was being played. What was
coming next? Would it be powerful, tender, dancing, or somber? I
felt at these times as though I were being teased, but so nicely,
so gently. I wanted to laugh in sheer appreciation of these
responses, regardless of where I had just been, how sad or awed.
And as soon as the music began, I was off again. Nor do I
remember all the explorations.
"Mainly I remember two experiences. I was alone in a
timeless world with no boundaries. There was no atmosphere; there
was no color, no imagery, but there may have been light. Suddenly
I recognized that I was a moment in time, created by those before
me and in turn the creator of others. This was my moment, and my
major function had been completed. By being born, I had given
meaning to my parents' existence.
"Again in the void, alone without the time-space
boundaries. Life reduced itself over and over again to the least
common denominator. I cannot remember the logic of the
experience, but I became poignantly aware that the core of life
is love. At this moment I felt that I was reaching out to the
world--to all people--but especially to those closest to me. I
wept long for the wasted years, the search for identity in false
places, the neglected opportunities, the emotional energy lost in
basically meaningless pursuits.
"Many times, after respites, I went back, but always to
variations on the same themes. The music carried and sustained
me. Occasionally, during rests, I was aware of the smell of
peaches. The rose was nothing to the fruit. The fruit was nectar
and ambrosia (life); the rose was only a beautiful flower. When I
finally was given a nectarine it was the epitome of subtle,
succulent flavor.
"As I began to emerge, I was taken to a fresh windswept
world. Members of the department welcomed me and I felt not only
joy for myself, but for having been able to use the experience
these people who cared for me wanted me to have. I felt very
close to a large group of people. Later, as members of my family
came, there was a closeness that seemed new. That night, at home,
my parents came, too. All noticed a change in me. I was radiant,
and I seemed at peace, they said. I felt that way too. What has
changed for me? I am living now, and being. I can take it as it
comes. Some of my physical symptoms are gone. The excessive
fatigue, some of the pains. I still get irritated occasionally
and yell. I am still me, but more at peace. My family senses this
and we are closer. All who know me well say that this has been a
good experience."
Five weeks after the date of the session, Gloria suddenly
developed ascites (accumulation of serous fluid in the abdominal
cavity) and had to be rehospitalized; she died quietly three days
later.
The result of Sidney Wolf's endeavor was so encouraging that
the Spring Grove staff decided to explore further the potential
of psychedelic therapy for alleviating the suffering of those
dying of cancer. A group of open-minded surgeons at Baltimore's
Sinai Hospital expressed interest in this procedure, offered
their cooperation, and agreed to refer patients for LSD therapy.
Three more persons were treated at this time by Sanford Unger, a
psychologist who had played an important role in launching the
Spring Grove studies of alcoholics and neurotics.
The next important step in this direction was made in late
1967, when Walter N. Pahnke joined the Spring Grove team. He was
instrumental in changing the initial interest of the staff into a
systematic pilot exploration and eventually a research project.
Pahnke's background made him ideally suited for this type of
work. He was a graduate of Harvard Medical School, and in
addition had a doctoral degree in comparative religion and a
degree in divinity.
It is hard to imagine a more useful way to combine medicine,
psychology, and religion than psychedelic therapy with dying
individuals. With unusual energy, enthusiasm, and devotion,
Pahnke assumed the role of principal investigator in the cancer
study. After pilot experimentation he was able to obtain
financial support from the Mary Reynolds Babcock Foundation. He
started a research program exploring the value of psychedelic
therapy utilizing LSD. Later he initiated a similar project in
which a short-acting psychedelic, dipropyltryptamine (DPT), was
used in lieu of LSD.
Walter Pahnke's life and work were drastically terminated in a
tragic accident on July 10, 1971. While vacationing in his summer
cabin in Maine, he did not return from one of his scuba-diving
expeditions. His body and diving equipment were never recovered
and the nature of the accident has remained a mystery. Walter's
demise was a great loss for the Spring Grove team, from the
personal as well as professional point of view. After Walter's
death the first author (S.G.) assumed medical responsibility for
the cancer study as his primary research activity and interest.
His objective was not only to complete the research projects and
accumulate enough data but also to formulate a theoretical
framework that would account for some of the dramatic changes
occurring as a result of LSD therapy. It seemed important at this
point to carefully analyze the data from LSD sessions of normal
volunteers, psychiatric patients, and dying individuals, and to
formulate a comprehensive theory of LSD therapy based on a new
model of the unconscious.
A new dimension was added to these endeavors when in 1972,
Joan Halifax, the second author, joined the team as co-therapist
and anthropological consultant. We could now combine our
backgrounds in experimental psychiatry and medical anthropology
and view the data from a broad cross-cultural perspective. It was
in this process of interdisciplinary cross-fertilization, when we
were working as a therapeutic dyad, sharing observations and
exchanging data, that the ideas expressed in this book started to
crystallize into their present form.

Note:

Although the Spring Grove psychedelic research continued
on until the mid-1970's, it, too, finally came to an end for
various reasons. Lack of new funding by the government,
discouragement of the workers involved in not obtaining
permission to carry out desired projects, continuing bad
publicity resulting from clandestine use of psychedelics, and
other factors could be cited. And so, by the late 1970's
essentially all psychedelic research in North America had
ceased, and what remained of European research was a mere
ghost of the promising work of the 1950's and 1960's.